In testimony in Judge Lawrence Karlton's courtroom, witnesses said low staff levels have contributed to patient deaths at the facility, and one former employee said administrators even pressured staff with a weekly patient discharge quota so waiting lists could be lowered.

Attorney Debbie Vorous, representing the state, said the federal court has never found that the Department of State Hospitals delivers inadequate care.

Acknowledging there have been "staffing fluctuations" at the Salinas Valley facility run by the state hospitals department, Vorous said, "that is not the same as deliberate indifference."

She said the department has been working hard to recruit more psychiatrists and has deployed "very creative strategies" to increase staff.

"There are sufficient numbers" at the Salinas Valley psychiatric program, she said.

The program's interim executive director Pamela Ahlin testified that currently there is the equivalent of 10.25 full-time psychiatrists at the facility. Earlier this year, the number dropped as low as seven or eight.

But with 342 patients as of Tuesday, the current ratio is one psychiatrist to 33 patients — far from the ratio of one doctor to 15 patients seen at other state hospitals, according to court testimony.

Psychiatrists from the program have said that levels have dipped dangerously low in the past year, and one expert witness said two patient deaths could have been prevented if more staff had been able to better supervise and treat them.

Attorney Michael Bien, who represents inmates in the 23-year-old "Coleman" lawsuit that led to a historic overhaul of California's state prisons, said that after 10 years with no patient deaths, there were two deaths in the last six months "related to serious understaffing" at the Salinas Valley facility.

"Peoples' lives are at stake," Bien told Karlton, asking that a court-appointed special master be ordered to investigate staffing problems and other issues at the facility.

Testimony on the matter is expected to last three days.

In testimony, expert witness Dr. Pablo Stewart said the death of a Salinas Valley patient in March by water intoxication was "very preventable."

The Herald has identified the patient as 36-year-old Desmond Watkins, who died from low blood sodium levels after drinking too much water because of a mental illness in which patients suffer from unquenchable thirst, according to a Monterey County Coroner's report.

Stewart said Watkins' extremely low blood sodium level indicated his excessive water intake "had been going on for quite a while."

Because Watkins had previously received emergency treatment for the same condition, Stewart said staff should have known to restrict his water intake and monitor his blood electrolyte levels.

Stewart said the suicide of another patient in November who had repeatedly attempted to take his life and had to wait three weeks for treatment also could have been prevented.

He said the patient scrawled a note on his cell wall saying, "I came here slightly depressed. Now I am severely depressed. This place is hopeless."

Former director of the California Department of Corrections and Rehabilitation Jeanne Woodford also testified, saying Salinas Valley's practice of taking up to 10 days to evaluate newly arrived patients before taking them off so-called "cuff status" can cause mental patient to deteriorate quickly. Cuff status means patients have almost no social contact, almost no programs, and are in handcuffs whenever they are outside their cells.

She said the classification process to get patients off cuff status and into therapy could be completed within 72 hours.

Bien said the state cut $9 million from the past year's budget for the facility, which led to extremely low staffing ratios.

Dr. Joel Badeaux, who left Salinas Valley in March, was one of nine psychiatrists who sent letters to the hospitals department complaining of high patient loads.

He said that before he left the program, an administrator sent an email to staff telling psychiatrists they should discharge 18 patients per week from the facility in order to reduce waiting lists. The department was under pressure to eliminate waiting lists, he said, because of previous rulings in the Coleman lawsuit.

The discharge quotas also came as the state was poised to ask Karlton and two others judges to stop federal oversight of prison mental health care, a bid that failed.

Badeaux testified that when he worked at Napa Valley State Hospital, also run by the Department of State Hospitals, he saw around 15 patients. At Salinas Valley, he said, he was responsible for a caseload of 60 patients, and twice that many on Fridays, when another psychiatrist had the day off.

Badeaux said he usually had to meet with patients at their cell doors because of a shortage of medically trained correctional officers to escort patient to meeting rooms.

That made therapy difficult, he said, because the patients have no privacy and other inmates could hear the doctor-patient conversations.

Part of the reason staff levels dropped so low was that state officials announced to Salinas Valley medical staff that because a new facility in Stockton is scheduled to begin taking patients in July, the program in Soledad would be cut by half, causing an exodus of psychiatrists and other staff who wanted more stable employment.

Badeaux said he's pleased by the department's recent efforts to get more psychiatrists hired, but said plans to move more than 200 Salinas Valley patients to Stockton this summer are cause for concern.